title: A midwifery-led in-hospital birth center within an academic medical center: successes and challenges.
abstract: The University of California San Diego Community Women's Health Program (CWHP) has emerged as a successful and sustainable coexistence model of women's healthcare. The cornerstone of this midwifery practice is California's only in-hospital birth center. Located within the medical center, this unique and physically separate birth center has been the site for more than 4000 births. With 10% cesarean delivery and 98% breast-feeding rates, it is an exceptional example of low-intervention care. Integrating this previously freestanding birth center into an academic center has brought trials of mistrust and ineffectual communication. Education, consistent leadership, and development of multidisciplinary guidelines aided in overcoming these challenges. This collaborative model provides a structure in which residents learn to be respectful consultants and appreciate differences in medical practice. The CWHP and its Birth Center illustrates that through persistence and flexibility a collaborative model of maternity services can flourish and not only positively influence new families but also future generations of providers.
authors.affiliation: Department of Reproductive Medicine, University of California San Diego, La Jolla, California (Mss Perdion, Lesser, and Hirsch, and Drs Kelly, Moore, and LaCoursiere) and Hahn School of Nursing and Health Science, University of San Diego, San Diego, California (Dr Barger). Ms Lesser is currently at Kaiser Permanente Walnut Creek, California.
authors.forename: Karen
authors.initials: K
authors.lastname: Perdion
authors.forename: Rebecca
authors.initials: R
authors.lastname: Lesser
authors.forename: Jennifer
authors.initials: J
authors.lastname: Hirsch
authors.forename: Mary
authors.initials: M
authors.lastname: Barger
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Kelly
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Moore
authors.forename: D Yvette
authors.initials: DY
authors.lastname: Lacoursiere
mesh_terms: D000046:Academic Medical Centers; D002140:California; D003299:Cooperative Behavior; D003696:Delivery Rooms / Q000706:statistics & numerical data*; D004493:Education; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008880:Midwifery / Q000379:methods / Q000458:organization & administration; D017146:Models, Organizational; D036801:Parturition; D010348:Patient Care Team; D018743:Perinatal Care / Q000379:methods / Q000458:organization & administration; D017410:Practice Guidelines as Topic; D057184:Practice Patterns, Nurses' / Q000706:statistics & numerical data*; D011247:Pregnancy; D011256:Pregnancy Outcome